Open Access
Research
Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy Mary T Korytkowski,1 Esra Karslioglu French,2 Maria Brooks,3 Dilhari DeAlmeida,4 Justin Kanter,5 Manuel Lombardero,6 Vasudev Magaji,7 Trevor Orchard,3 Linda Siminerio8 To cite: Korytkowski MT, Karslioglu French E, Brooks M, et al. Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy. BMJ Open Diabetes Research and Care 2016;4: e000206. doi:10.1136/ bmjdrc-2016-000206
▸ Additional material is available. To view please visit the journal online (http://dx. doi.org/10.1136/bmjdrc2016-000206). Received 3 February 2016 Revised 30 March 2016 Accepted 2 May 2016
This final article is available for use under the terms of the Creative Commons Attribution Non-Commercial 3.0 Licence; see http://drc.bmj.com
ABSTRACT Background: The increasing use of electronic health records (EHRs) in clinical practice offers the potential to investigate cardiovascular outcomes over time in patients with type 2 diabetes (T2D). Objective: To develop a methodology for identifying prevalent and incident cardiovascular disease (CVD) in patients with T2D who are candidates for therapeutic intensification of glucose-lowering therapy. Methods: Patients with glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol) while receiving 1–2 oral diabetes medications (ODMs) were identified from an EHR (2005–2011) and grouped according to intensification with insulin (INS) (n=372), a different class of ODM (n=833), a glucagon-like peptide receptor 1 agonist (GLP-1RA) (n=59), or no additional therapy (NAT) (n=2017). Baseline prevalence of CVD was defined by documented International Classification of Diseases Ninth Edition (ICD-9) codes for coronary artery disease, cerebrovascular disease, or other CVD with first HbA1c ≥7% (53 mmol/mol). Incident CVD was defined as a new ICD-9 code different from existing codes over 4 years of follow-up. ICD-9 codes were validated by a chart review in a subset of patients. Results: Sensitivity of ICD-9 codes for CVD ranged from 0.83 to 0.89 and specificity from 0.90 to 0.96. Baseline prevalent (INS vs ODM vs GLP-1RA vs NAT: 65% vs 39% vs 54% vs 59%, p
Research
Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy Mary T Korytkowski,1 Esra Karslioglu French,2 Maria Brooks,3 Dilhari DeAlmeida,4 Justin Kanter,5 Manuel Lombardero,6 Vasudev Magaji,7 Trevor Orchard,3 Linda Siminerio8 To cite: Korytkowski MT, Karslioglu French E, Brooks M, et al. Use of an electronic health record to identify prevalent and incident cardiovascular disease in type 2 diabetes according to treatment strategy. BMJ Open Diabetes Research and Care 2016;4: e000206. doi:10.1136/ bmjdrc-2016-000206
▸ Additional material is available. To view please visit the journal online (http://dx. doi.org/10.1136/bmjdrc2016-000206). Received 3 February 2016 Revised 30 March 2016 Accepted 2 May 2016
This final article is available for use under the terms of the Creative Commons Attribution Non-Commercial 3.0 Licence; see http://drc.bmj.com
ABSTRACT Background: The increasing use of electronic health records (EHRs) in clinical practice offers the potential to investigate cardiovascular outcomes over time in patients with type 2 diabetes (T2D). Objective: To develop a methodology for identifying prevalent and incident cardiovascular disease (CVD) in patients with T2D who are candidates for therapeutic intensification of glucose-lowering therapy. Methods: Patients with glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol) while receiving 1–2 oral diabetes medications (ODMs) were identified from an EHR (2005–2011) and grouped according to intensification with insulin (INS) (n=372), a different class of ODM (n=833), a glucagon-like peptide receptor 1 agonist (GLP-1RA) (n=59), or no additional therapy (NAT) (n=2017). Baseline prevalence of CVD was defined by documented International Classification of Diseases Ninth Edition (ICD-9) codes for coronary artery disease, cerebrovascular disease, or other CVD with first HbA1c ≥7% (53 mmol/mol). Incident CVD was defined as a new ICD-9 code different from existing codes over 4 years of follow-up. ICD-9 codes were validated by a chart review in a subset of patients. Results: Sensitivity of ICD-9 codes for CVD ranged from 0.83 to 0.89 and specificity from 0.90 to 0.96. Baseline prevalent (INS vs ODM vs GLP-1RA vs NAT: 65% vs 39% vs 54% vs 59%, p
